Trocar sleeve

ABSTRACT

A trocar sleeve that isolates the surgical device or movement thereof to inhibit or prevent an established non-jet streaming condition from becoming a jet streaming condition and a method of inhibiting or preventing a jet streaming condition from occurring due to instrument obstruction.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/658,086 filed Feb. 2, 2010, which is a continuation of U.S. patentapplication Ser. No. 11/058,435 filed Feb. 15, 2005 now U.S. Pat. No.7,722,558.

FIELD OF THE INVENTION

This invention relates to the field of medical devices, and morespecifically to a trocar sleeve for delivery of an insufflation fluid ina non jet-streaming condition regardless of whether instruments arepresent in the trocar sleeve.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

None

REFERENCE TO A MICROFICHE APPENDIX

None

BACKGROUND OF THE INVENTION

A physician can use a trocar device to deliver fluid into a body cavityduring specific medical procedures or treatments. The purpose of usingsuch a device is to inflate or distend the body cavity to allow thesurgeon (1) exploration of the area in which the surgery will beperformed and (2) to provide a view of the site to be treated orobserved. Insufflation is used in many common procedures includingendoscopic surgical procedures, laparoscopic procedures performed on theabdominal cavity and thoracoscopic procedures performed on the chestcavity.

At the beginning of the procedure, the surgeon cuts an incision totraverse the skin and tissue layers until the body cavity is opened. AVerres need is inserted to start insufflation. A Verres needle may beused, however a trocar can be placed directly without use of a needle toenter the body cavity. An external, pressurized fluid source isconnected to the needle. The fluid flows from the proximal end of theneedle to a distal end thereof from which the fluid exits and isdelivered into the body cavity. This causes the tissue layers todistend, a process known as insufflation. Carbon dioxide gas is commonlyused for insufflation and other substances, which may include drugs andanesthetics may be mixed with the carbon dioxide gas and administeredsimultaneously.

After satisfactory insufflation, the needle is removed and a trocarsleeve may be inserted through the incision and into the body cavity.Trocar sleeves are sized and shaped to pass through the incision andtissue layers of a body so that the sleeve penetrates at least partiallyinto the body cavity. Cameras and/or surgical devices may be insertedinto the sleeve to provide the surgeon with a view of the surgical siteor to allow the surgeon to treat the area.

My U.S. Pat. No. 6,733,479 discloses, a trocar sleeve with a pluralityof apertures that address the problem of the “jet streaming effect” andis hereby incorporated by reference. The “jet streaming effect” is knownto damage tissues and/or organs of the body because as the fluidcontacts those surfaces, the lining of the body cavity and the surfacesof the organs housed therein undergo severe heat loss. The effect ismore fully described in U.S. Pat. No. 6,733,479 and references citedtherein. To eliminate or reduce the “jet streaming effect” my priorpatent discloses a series of apertures located along the trocar sleeveto effectively distribute the gases at velocities, which are below thethreshold of the “jet streaming effect”. While the perforated trocargreatly reduces or eliminates the “jet streaming effect” there can betransient conditions when an instrument can periodically obstruct thetrocar sleeve and therefore temporarily affect the fluid flow throughthe trocar sleeve and possibly cause localized regions on the trocarsleeve where the “jet streaming conditions” could occur. For example, amanipulation of an instrument such as surgical device within the trocarsleeve or the insertion of an irregular shaped instrument might blockoff a substantial portion of the trocar sleeve thereby increasingvelocity at other regions of the trocar sleeve until the jet streamingvelocity is exceeded. Since this condition is most likely to occur in alocalized area and might be only a temporary condition the user mightnot even know that a “jet streaming condition” is occurring at some ofthe apertures in the trocar sleeve.

The present invention provides a solution to the problem of transientconditions that can produce localized “jet streaming conditions” byproviding a trocar sleeve that does not produce a “jet streamingcondition” even though different size and shape instruments are insertedinto the trocar sleeve. Furthermore, the instruments can be manipulatedin the trocar sleeve without fear of inducing a localized “jet streamingcondition”. A further embodiment of the invention eliminates the “jetstreaming condition” through eliminating of instruments in the trocarsleeve that is used to deliver fluids to a body cavity.

The present invention is a trocar sleeve for insufflating the bodycavity without damaging a tissue in the body cavity due to transientflow conditions. More specifically, the invention includes a trocarhaving a fluid flow chamber that delivers an insufflating fluid at avelocity below a jet streaming velocity whether or not an instrumentsuch as a camera or a surgical device is in the lumen in the trocarsleeve. In one embodiment a double walled trocar sleeve is used toinhibit or prevent the “jet streaming condition” and in anotherembodiment a blind trocar sleeve is used to inhibit or prevent the “jetstreaming condition”. In both embodiments, the invention provides afluid flow condition that is not affected by instruments.

BRIEF SUMMARY OF THE INVENTION

Briefly, one embodiment of the invention comprises a trocar sleevehaving an inner wall that isolates an instrument in the trocar sleevefrom the insufflation fluid and in another embodiment a blind trocarsleeve is used for insufflations purposes while a conventional trocarsleeve is used for the surgical procedures but not for introducing theinsufflating fluid.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of the trocar sleeve;

FIG. 2 is a cross-sectional view of the trocar sleeve taken along lines2-2 of FIG. 1 illustrating the flow of fluid;

FIG. 3 is side view of the alternate embodiment blind trocar sleeve; and

FIG. 3A is a cut away and enlarged view of a portion of the alternativeembodiment the blind trocar sleeve of FIG. 3.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring to FIG. 1 and to FIG. 2 the present invention provides atrocar sleeve 10 for insufflating a body cavity while minimizing oreliminating damage to a tissue in the body cavity that can occurproximate the cylindrical member 11 of trocar sleeve 10. Typically, thetrocar sleeve is inserted into the body cavity 13 of an animal or humanby creating an opening within the body that extends through many layersof tissue 20, which include skin, fat, muscle, and pre-pleural orpre-peritoneal in either the thoracic or abdominal cavities,respectively.

FIG. 1 shows trocar 10 that addresses the problem of transient “jetstreaming conditions” that can occur because of partial obstructionswithin the lumen caused by the insertion of an instruments such as asurgical device through the trocar sleeve 10. Such obstructions, whichreduce the diameter of the lumen, can result in high-pressure fluiddelivery to the body cavity at localized region proximate the trocarsleeve 10 and thus cause damage to the tissues and/or organs of thebody.

FIG. 1 shows trocar sleeve sleeve 10 in a partial cut away view. Thetrocar sleeve includes a housing 16. Attached to the housing is an inletport 15. A cylindrical member or tube 11 is attached to the housing andis formed about a central longitudinal axis A_(x) of the trocar sleeve.The cylindrical member 11 has a proximal end 12 and spaced distallytherein is a distal end 14. A spaced plurality of apertures 19 isdefined within the exterior of the body surface of the cylindricalmember 11. The plurality of apertures 19 are regularly spaced from oneanother and extend at least partially from the distal end 14 toward theproximal end 12 of the trocar sleeve. The plurality of apertures 19 canextend the entire length of the trocar sleeve if so desired, or for anydesired length along the trocar sleeve. It is anticipated that althoughthe respective apertures may extend along the entire length of thetrocar sleeve if so desired, the apertures will preferably be spacedfrom the proximal ends.

Within the cylindrical member 11 and attached to the housing 16 is acylindrical member or tube 22 having a sidewall 22 a which is imperviousor substantially impervious to fluid flow therethrough.

FIG. 2 shows a cross section view revealing the outer elongated tube orcylindrical member 11 having the apertures 19 therein. Locatedconcentrically within cylindrical member 11 is a further elongated tubeor cylindrical member 22 having the sidewall 22 a impervious to fluidflow with sidewall 22 a spaced from inner sidewall 11 a of tube 11 toform an annular chamber 30 for fluid to flow therethrough. Positionedwithin lumen 31 of cylindrical member 22 is the instrument comprisingtrocar 21, which is shown occupying a central portion of the lumen 31.In use, the trocar 21 might occupy more or less of the lumen 31. Thelumen 31 is used for manipulating the instruments and is isolated fromthe annular chamber 30. That is, the lumen 31 is not used to deliver theinsufflation gas to the patient any consequently manipulation of thesurgical device 21 within the lumen 31 does not have any effect on theflow through the annular chamber 30 and hence through the radialapertures 19. Thus, once a “non jet streaming condition” is establishedat apertures 19 any changes in the position of the instrument or thetype of instrument in the lumen 31 will not have any effect on thevelocity of the fluids escaping from the apertures since the flowthrough the apertures is isolated from the instruments located in thelumen 31 of the trocar sleeve 10. Thus, the present invention is wellsuited for those applications where the instruments inserted through thetrocar sleeve are of different size or shape since the size, shape orthe position of the instrument does not effect the flow through thetrocar sleeve 11. In addition, any repositioning of the instruments inthe lumen 31 will not have any effect on flow conditions through thetrocar sleeve since the fluid flow is independent of conditions in lumen31.

FIG. 2 illustrates the radial fluid flow through trocar sleeve 10. Aninsufflating fluid, “F”, which may be gas, liquid containing drugs,anesthetic or other substances placed or mixed within a pharmaceuticallyacceptable carrier or any combination thereof. The fluid “F” isdelivered under pressure from an external source via inlet port 15,travels through the annular fluid flow chamber 30 and is discharged atbelow a “jet streaming velocity” through the plurality of apertures 19as indicated by the arrows. Thus regardless of whether an instrument ispresent in lumen 31 or whether an instrument is manipulated in lumen 31it will not have an effect on the fluid conditions through the aperturesor fluid ports 19.

FIG. 3 illustrate an alternate embodiment 40 of the invention wherein a“non-jet streaming condition” can also be maintained. Specifically, theembodiment 40 includes a housing 46 and attached to the housing is aninlet port 45 and a tube or cylindrical member 41 having a proximal end42 and spaced therefrom a distal end 44. Along the exterior surface ofthe cylindrical member 41 is a plurality of fluid ports or apertures 49.As can be seen in FIG. 3 the arrows indicate an insufflation fluid isdirected radially outward from the apertures 49 and is maintained at anon jet streaming velocity by control pressure conditions withincylindrical member 41. Thus by having member 41 having a chamber 47therein with 41 apertures sufficiently small to preclude insertions ofinstruments therethrough one ensures that instruments will not beinserted into trocar sleeve 40 and adversely affect the established nonjet streaming conditions.

FIG. 3A is a partial cut away view of the cylindrical member 41revealing an end member 48 blocking the end of cylindrical member 41 toprovide a closed end of trocar sleeve 40 to prevent extension of aninstrument or other device into plenum chamber 47. This allows one toestablish fluid flow conditions in plenum chamber 47 that produce fluidvelocities through apertures 49 that are below a “jet streamingvelocity” and will remain at below a “jet streaming velocity” since noinstruments or other devices are inserted into the plenum chamber 47 toaffect the velocity of the fluid discharged through apertures 49.

FIG. 3 and FIG. 3A show insufflating fluid flow delivered from withinthe blind trocar sleeve 40. In operation fluid flows from an externalsource under pressure through the inlet port 45, is carried through thecylindrical member 41 and flows into plenum chamber 47 and through theplurality of apertures 49 into the body cavity 43. In the embodiment ofFIGS. 3 and 3A because the trocar sleeve is blind no instrument can beinserted therethrough. Since no instrument can be inserted therein oneneed not be concerned with the size, shape or type of instrument as wellas the position of the instrument affecting the fluid flow conditionsproximate the cylindrical member 41. Thus once the “non-jet streamingcondition” is established in trocar sleeve 40 one can be assured thatthe non-jet streaming condition can be maintained proximate the trocarsleeve 40. However, if a surgical instrument needs to be inserted intothe body cavity it can be inserted into a companion or separate trocarsleeve that does not contain the insufflation gas. The end 48 may or maynot have apertures 49 to allow fluid flow as well as from the side wall.

Thus, the invention includes the method of insufflating a body cavitywithout damaging a tissue in the body cavity that can occur duringtransient conditions within the trocar sleeve by directing a fluid flowfrom a first chamber in a trocar sleeve through apertures in the trocarsleeve at a velocity less than a jet streaming velocity while insertingor manipulating an instrument in a further chamber that is isolated fromthe first chamber to prevent the instrument therein from affecting theflow of fluid from the first chamber to thereby maintain the velocity ofthe fluid at less than the jet streaming velocity.

I claim:
 1. A method of performing a surgical procedure, comprising:inserting a trocar sleeve into a body cavity, the trocar sleevecomprising an outer wall and an inner wall with the trocar sleeve havinga first lumen located between the outer wall and the inner wall and asecond lumen, located within the inner wall with, the first lumenfurther comprising a plurality of apertures in the outer wall, thetrocar sleeve further comprising an inlet port adapted to receive aninsufflation gas, the inlet port in flow communication with the firstlumen; a received insufflation gas through the first lumen via the inletport, wherein at least a portion of the received insufflation gas exitsthe first lumen and enters the body cavity through the plurality ofapertures; and inserting and removing an instrument from the secondlumen.
 2. The method of claim 1, wherein the instrument comprises atrocar.
 3. The method of claim 1, wherein the instrument comprises asurgical device.
 4. The method of claim 1, wherein the instrumentcomprises a camera.
 5. The method of claim 1, wherein the first lumen iscoaxial with the second lumen.
 6. The method of claim 1, wherein theflow of gas discharges from the plurality of apertures in a non jetstreaming condition.
 7. The method of claim 1, wherein the plurality ofapertures is regularly spaced from one another.
 8. The method of claim1, wherein the plurality of apertures is randomly spaced from oneanother.
 9. The method of claim 1, wherein the first lumen receives thegas from an inlet port and wherein the inlet port does not supply anygas to the second lumen.
 10. The method of claim 1, wherein the gas iscarbon dioxide.
 11. The method of claim 1, wherein the second lumen isnot used to deliver insufflation gas to the patient while the gas isflowing through the first lumen.
 12. The method of claim 2, wherein thefirst lumen is coaxial with the second lumen.
 13. The method of claim 2,wherein the flow of gas discharges from the plurality of apertures in anon jet streaming condition.
 14. The method of claim 2, wherein thefirst lumen receives the gas from an inlet port and wherein the inletport does not supply any gas to the second lumen.
 15. The method ofclaim 2, wherein the second lumen is not used to deliver insufflationgas to the patient while the gas is flowing through the first lumen. 16.The method of claim 5 wherein the flow of gas discharges from theplurality of apertures in a non-jet streaming condition.
 17. The methodof claim 5, wherein the first lumen receives the gas from an inlet portand wherein the inlet port does not supply any gas to the second lumen.18. The method of claim 5, wherein the second lumen is not used todeliver insufflation gas to the patient while the gas is flowing throughthe first lumen.
 19. The method of claim 2, wherein the first lumen iscoaxial with the second lumen; and wherein the first lumen receives thegas from an inlet port and wherein the inlet port does not supply anygas to the second lumen.
 20. The method of claim 19, wherein the inletport receives the gas from a pressurized source.
 21. The method of claim19, wherein the flow of gas discharges from the plurality of aperturesin a non-jet streaming condition.
 22. The method of claim 9 wherein theinlet port receives the gas from a pressurized source.
 23. The method ofclaim 19, wherein the inlet port receives the gas from a pressurizedsource; and wherein the flow of gas discharges from the plurality ofapertures in a non-jet streaming condition.